AB0283 FATIGUE AND DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS. A RESIDUAL FATIGUE OF HIGH LEVEL CAN BE OBSERVED EVEN IN LOW DISEASE ACTIVITY.
Authors: R. Morlà, B. Frade-Sosa, N. Sapena, J. A. Gómez-Puerta, R. Sanmartí
Journal: Annals of the Rheumatic Diseases (2022)

Background Fatigue is a major symptom suffered by patients with rheumatoid arthritis (RA), with a high prevalence (40%-70%) 1 . Different questionnaires and scales (BRAF, FACIT, SF36v, MDHAQ, VAS...) have been validated, but none have been standardized to measure it. In observational studies, the VAS (0-10) scale was reported as a good measure for fatigue; cut-off&gt;5/10 indicates high level 2 . A residual fatigue in low activity/remission of the disease has been described in a significant proportion of patients 3 . Objectives We studied the association with high level of fatigue and the clinical disease activity in non-selected RA patients. Methods RA patients (ACR/EULAR criteria, 2010) were included consecutively in our Arthritis Unit during a period of 3 months. Patients completed 2-pages MDHAQ that includes a VAS 0-10 for fatigue at question 9, in addition to other queries: physical function (FN) + pain (PN) + patient global assessment (PATGL), checklist of 60 symptoms (ROS60) and self-assessment 48 joint count (RADAI48). VAS for Fatigue was calculated with a cut-off point ≥5/10 to obtain the group with high fatigue. Demographic variables (age, sex, BMI) and clinical variables: disease duration, treatment with bDMARDs and glucocorticoids, joint physical examination (TJC 0-28, SJC 0-28), acute phase reactants (ESR, CRP), physician global assessment (PhyGL), and the rates of clinical activity with their respective clinically significant differences (DAS28-ESR&gt;0.6; SDAI&gt;10; RAPID3&gt;3.8) were also calculated. A descriptive analysis (mean and SD) of all the variables, a bivariate analysis to compare groups (Student t for quantitative and Chi 2 tests for categorical variables) and calculation of numerical differences between indices was performed. Results A total of 75 RA patients (84% females) were recruited, of mean age of 62 (SD:11.6) years, with media BMI of 22.8 (SD:8.0), mean disease duration of 14.6 (± 5) years, 16% depressed (PHQ9≥10), treated with bDMARD (64%) and glucocorticoids (45,3%). Means of disease clinical indexes were as follows: DAS28-ESR (2.55, SD:1.21), SDAI (8.7, SD:8.00) and RAPID3 (5.97, SD:5.85). In 31 (41.2%) of patients we observed high fatigue (VAS-fatigue≥5/10). When comparing with those with low or no fatigue levels, these patients have higher disease activity measured by the composite activity indices and acute phase reactants except for the SJC. All self-reported variables evaluated by MDHAQ (FN, PN, RADAI48, ROS60) were also higher in patients with high fatigue levels (Table 1). Table 1. Descriptive and comparison variables between groups, expressed as mean and SD. All patients, n=75 Non-high fatiguegroup,n=44 (58.6%) High fatiguegroup, n=31 (41.3%) pvalue TJC (0-28) 1,45 (2,81) 0,59 (1,21) 2,68 (3,84) 0.001 SJC (0-28) 1,23 (2,18) 0,96 (1,94) 1,63 (2,47) 0.200 PCR 0,7 (0,97) 0,47 (0,29) 1,02 (1,42) 0.014 ESR 13,9 (15,0) 10,52 (9,44) 18,68 (19,56) 0.019 FN (0-10) 1,26 (1,82) 0,72 (1,23) 3,20(2,39) 0.004 PN (0-10) 3,56 (3,12) 1,90 (2,28) 5,30 (2,98) &lt;0.001 PATGL (0-10) 3,27 (2,86) 2,07 (2,24) 5,18 (2,77) 0.001 RADAI48 (0-48) 7,85 (8,81) 4,14 (5,50) 12,87 (9,99) &lt;0.001 ROS60 (0-60) 10,06 (8,84) 5,78(5,03) 15,71 (9,64) &lt;0.001 PhyGL (0-10) 2,43 (1,94) 1,90 (1,47) 3, 18 (3,27) 0.004 DAS28-ESR 2,55 (1,21) 2,13 (0,97) 3,15 (1,27) 0.001 SDAI 8,7 (8,0) 6,18 (4,80) 12,33 (10,01) 0.001 RAPID3 (0-30) 5,97 (5,85) 3,08 (3,48) 10,29(0,06) &lt;0.001 The mean differences in the three activity indices between both groups were statistically significant, in the DAS28-ESR and RAPID3 were also considered clinically relevant: 1.02 (&gt;0.6) and 7.2 (&gt;3.8) respectively, but not for SDAI: 6.15 (&gt;10). Conclusion Even non-selected RA patients but with low disease activity, high fatigue level was common. For a better approach to fatigue in RA patients, it would be interesting not to forget this residual fatigue. References [1]Hewlett S, et al. Rheumatology 2011;50:1004-6. [2]Pollard LC, et al . Rheumatology 2006;45:885-9. [3]Druce K, et al . Rheumatology 2016;5:1786-90. Disclosure of Interests Rosa Morlà: None declared, Beatriz Frade-Sosa: None declared, Nuria Sapena: None declared, José A Gómez-Puerta Speakers bureau: Abbvie, BMS, Galápagos, GSK, Janssen, MSD, Lilly, Pfizer, Roche, Consultant of: Galapagos, Roche, Sanofi, Raimón Sanmartí Speakers bureau: Abbvie, BMS, Gebro-Pharma, Lilly, MSD, Pfizer, Sanofi, Roche